The harsh reality of starting a new hospitalist program is that there are those in that hospital that will embrace it and those that just won’t, no matter what. People fear change, even if it is to their benefit. The old guard of specialists and surgeons at our newest site is a perfect example of how tricky new start-up programs are.
AIM took over its latest site in October of 2013. (Which is why I haven’t had much time to blog!) It became apparent very quickly that not everyone was happy to see us. After a few weeks, we figured out why. The specialists and surgeons dominated the hospital from top to bottom, and they were completely out of control. Consultants consult multiple other consultants, surgeons count the number of consults our team writes for them versus other docs in the same specialty, and make sure that they exact every nickel out of a patient regardless of length of stay or any quality metrics. It borders on unethical. Pulmonologists argued that our hospitalists weren’t qualified to provide ventilator management, even though it was part of our credentials. They didn’t argue because of patient safety, but purely because of economics. Every aspect of this inpatient care facility was doctor driven, with no regard for input from other personnel, including, in many cases, the patient. So, here comes our new hospitalist group into the fire. We started off by creating a multidisciplinary team to increase efficiency and communication between departments. We pushed administration to support us as we fought the cardiology groups to start performing stress tests and echoes on weekends to improve the dismal length of stay at the facility. (They were contracted to do so, but it had never been enforced.) We worked with radiology to be able to obtain MRIs on weekends as well. We knew Rome wasn’t created in a day, but we have begun to make inroads. Fortunately, administration realized the cost savings potential and has been backing us soundly since day one.
On and on it went, seemingly every few days receiving a complaint or pushback from someone who was only interested in their own bottom line. It demonstrated the sad state of affairs that is much of the fee-for-service landscape that many cling to since they know how to take full financial advantage. When I extrapolate what is going on here nationally, it is no wonder there is a health care crisis! Pay-for-performance means accountability. When we bring up national measures like the Choosing Wisely campaign, it is intended to stop waste. The amount of waste going on at this one facility alone shows the problem on a frightening scale. Absolute power corrupts absolutely, right? Well, physicians in this facility have too much power. We need to create a patient-centric, TEAM approach to health care. That is the only way to create the safest, highest-quality, and most cost-effective hospital environment. So many are still trying to cling to the ‘good ol’ days’, when doctors could seemingly do whatever they wanted. Well, our team embraces the challenge of helping to change from a fee-for-service to a pay-for-performance environment. We aren’t afraid to partner with nurses, case managers, and patient educators. In fact, we are trying to bring them into our patient care model. That’s why we’ve been successful & why AIM is growing in size and reputation. It also doesn’t hurt that this model saves hospitals enormous amounts of money in the process. That’s why we want hospitalists on our team who can work as total team players. They can take great care of a single patient at the bedside, but also help to improve the entire system and process from admission to discharge.
Changing a hospital landscape that is so uninterested in a progressive model of team-based health care that is cost-effective and of the highest quality is an enormous challenge. AIM embraces that challenge. It is very rewarding to see the buy-in from nurses and other ancillary personnel that are now being asked their opinions on patient care. Now, all we need to do is get the physicians, especially the specialists and surgeons, to start practicing medicine like they care about something other than their own bottom line. With time, they’ll come around. Guess what? If they don’t, the train isn’t waiting for them, folks. This is the way of medicine in 2014. Guess what else? It’s a better way.